Supporting Statement A

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0935-0179 )

T ITLE OF INFORMATION COLLECTION:

Focus Groups on TeamSTEPPS^® for Long-Term Care Curriculum

PURPOSE:

Teamwork has been found to be one of the key initiatives within patient safety that can transform the culture within health care. If the TeamSTEPPS tools and information are to be widely adopted, the curriculum must be accessible and relatable to providers. Testing the materials with active practitioners will help to ensure that the curriculum resonates in practice, not just in theory, offering invaluable insight into how hypothetical users would interact with the tools and information in the TeamSTEPPS for Long-Term Care curriculum.

Information collected during these focus groups will be used both in the immediate future and at a later date. The findings will address the accuracy, overall value, and presentation of the tools and information contained in the curriculum, as well as gauge the ease of practical implementation and maintenance in the long-term care setting.

DESCRIPTION OF RESPONDENTS:

There are two primary audiences for the focus groups: (1) Certified nursing assistants, and (2) mixed long-term care professionals, including, but not limited to, physicians, nurses, dietitians, and physical therapists.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[X] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Joanne Robinson_______________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No [X] N/A

Personally identifiable information will consist only of first and last name when collected by the focus group facilities during their participant recruiting process. In our agreement with the facilities, the contractor team will stipulate that all last names are stripped from their records before the list of candidates is presented to the contractor team for selection of participants. Facilities will be instructed to delete digital copies of these records and shred any physical copies. Additionally, in the moderator guide and focus group feedback form, we note that information will not be collected or stored, and that participants will only ever be asked for their first name.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [X] Yes [ ] No

Group participants will receive an honorarium of $80, $120, or $250 for 90 minutes’ time, depending on their professional role. Certified nursing assistants (CNAs) will receive an honorarium of $80; the mixed selection of medical professionals will receive an honorarium of $120; and physicians will receive an honorarium of $250.

Our figures for the incentives are based on two factors: The mean hourly wage, and the recommendation from the focus group facilities that will be handling recruitment. Market research indicates the mean hourly wage for physicians and surgeons to be $95.05 (from the Bureau of Labor Statistics seen here, occupation code 29-1069), and our focus group facilities recommended an incentive of $400 for that professional role. By splitting the difference between those two figures, we arrived at a final figure of $250.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Certified Nursing Assistants	42	90 minutes	63 hours
Mixed Long-Term Care Professionals	30	90 minutes	45 hours
Totals	72	-	108 hours

FEDERAL COST: The estimated annual cost to the Federal government is: $188,808. This amount is based on the established budget for Task 3 in Contract No. HHSA 290 2012 00022I Task Order #2 TeamSTEPPS® in Long-Term Care.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Identification of potential candidates will be the responsibility of the focus group facilities in each city. These facilities are experienced in the recruitment of professionals from the medical field, and more specifically, the long-term care field, and will be able to provide a broad selection of candidates in the targeted professional roles.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[X] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Appendices

1. Appendix A – Focus Group Screener Guide

2. Appendix B – Moderator Guide

3. Appendix C – Focus Group Feedback/Exit Survey

4. Appendix D – Discussion Materials for Focus Groups

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